The role of community health workers in supporting South Africa’s HIV/ AIDS treatment programme

Abstract

Community health workers deployed around South Africa's primary health care clinics, supply indispensable support for the world's largest HIV/AIDS treatment programme. Interviews with these workers illuminated the contribution they make to anti-retroviral treatment (ART) of HIV/AIDS patients and the motivations that sustain their engagement. Their testimony highlights points of stress in the programme and supplies insights into the quality of its implementation. Finally, the paper addresses issues about the sustainability of a programme that depends on a group of workers who are not yet fully incorporated into the public sector.

Sustaining the National Health Insurance Scheme in South Africa: The Roles and Challenges of Community Health Workers

“…CHWs in South Africa are people from the communities without a formal professional training or degree, who have been selected, or, who have volunteered to perform functions related to healthcare delivery [8]. This job is usually taken up by females in their thirties and forties [9]. Some of these CHWs only hold the Matriculation (Grade 12) certificatean evidence of completion of secondary education, while others do not complete secondary school (Mottiar & Lodge, 2018).…”

“…This job is usually taken up by females in their thirties and forties [9]. Some of these CHWs only hold the Matriculation (Grade 12) certificatean evidence of completion of secondary education, while others do not complete secondary school (Mottiar & Lodge, 2018). However, many of them receive some form of training in health care by completing the National Certificate in home-based care (NQF level 1).…”

“…Initially, all CHWs perform their roles voluntarily and were not being paid. However, provincial governments eventually took up the responsibility of paying them hourly either through Non-Governmental Organizations (NGOs) or directly [9]. Most of them receive a meagre stipend at an average rate of R21.50 per hour or less and work 8 hours daily for 5 days in a week; most do not receive the stipends regularly, while some do not receive it at all [9,10].…”

“…However, provincial governments eventually took up the responsibility of paying them hourly either through Non-Governmental Organizations (NGOs) or directly [9]. Most of them receive a meagre stipend at an average rate of R21.50 per hour or less and work 8 hours daily for 5 days in a week; most do not receive the stipends regularly, while some do not receive it at all [9,10]. Many of them consider this stipend as grossly inadequate because they needed to use transport to get to the households within the communities where they work on a daily basis [10].…”

Exploring adaptations and successful implementation of Traditional Healers as adherence partners for people living with HIV in rural Mozambique: A qualitative assessment

“…Evidence-based interventions address barriers to medication retention by shifting the task from overburdened health facilities to community health workers for ART provision and education and emphasizing a more patient-centered approach via community ART distribution points, 27,28 adherence clubs, [28][29][30][31][32] home-based and spaced re ll visits, 33,34 and employing community health workers (CHWs) for ART provision and education. [35][36][37][38] When implemented with delity, CHW programs have shown to increase patient adherence to ART, leading to improved viral suppression. 39 In rural Mozambique, CHWs have struggled to effectively implement interventions due to a lack of transport (to conduct home visits), insu cient and irregular training programs, poor integration to the clinical system, the frequent turnover among volunteer staff 37,38,40 and low levels of patient trust.…”